Wednesday, August 22, 2018

Nothing divides the professional and
academic community who work in the field of sexual abuse quite like the
polygraph. It is a debate that has gone on internationally for decades. A
fascinating wrinkle in policy and the law recently came to the authors’
attention. In at least one state in the USA, there is a policy holding that
people on probation cannot be sent back to prison for failing a polygraph
examination; which makes sense given the status of the research around the
polygraph and its admissibility in court. However, in this state, the same
people can be sent back to prison if the examiner believes they have
deliberately manipulated the results of the test. This has resulted in at least
one examiner expressing certainty that many of his examinees have tried to
influence the results, with many of them becoming incarcerated because of the
examiner’s belief. Which highlights the main issue that the polygraph faces, that
there are a multitude of different audiences (public, judiciary, professionals,
academics, etc) all with different attitudes, experiences, evidence bases and
strongly held views around it.

We want to be clear that this is more a
problem of how professionals use or even abuse the power that they have over
clients/examinees than it is about the polygraph itself, although empirically
separating the effects of the polygraph from the examiner may be more
complicated than many would think. The good news is that the Department of Corrections
in that state is having a fresh look at its policies. The bad news is the
context of professionals believing in their approach to the detriment of their
clients. In some cases, one wonders how much deception by the examiner in the
process is acceptable given the potential costs and lack of truly informed
consent. These kinds of ethical questions certainly exist elsewhere,
but rarely get the attention they deserve with vulnerable populations such as
those for whom basic liberties are in the balance.

To put all of this into perspective, it
can be useful to review what research has shown time and again: Punishment on
its own neither reduces risk nor deters crime. While many questions about
treatment remain debatable, people who complete treatment programs emerge at
lower risk. Community supervision can also further reduce risk, and yet there
is still no credible evidence that the polygraph, as currently applied, is
improving outcomes, except in the opinions of its adherents.

This, in turn leads to further questions.
When we apply the polygraph as described above, with examiners being able to
send people to prison so easily, at what point are we not only interfering with
methods that would promote community safety, but also denying justice? (as a
side note, it is important to note that others in our field, including
therapists, can also wield undue negative influence under the wrong conditions).

We then need to turn to other questions,
such as what our goals actually are? Are we using the available methods to
reduce risk? Build better lives? Assist those who have been abused? Or continue
the punishment? Our belief is that punishment is punishment and rehabilitation
is rehabilitation, and that when we confuse the two, neither can be entirely
effective.

Finally, there is a real question of the
polygraph’s best use. Does a sexual history polygraph really provide as much
information as one might hope or is an examination into whether someone is
basically following the rules help them – and the community – more. Do other
methods, such as polygraphing people on their thoughts and fantasies simply
muddy the waters through a belief that one’s fantasies equals their future
behavior”?

Additionally, we would also encourage a
consideration of how the polygraph is used internationally. While the polygraph
is not necessarily an example of American exceptionalism, it might as well be
because most other countries internationally do not use the polygraph in the
same way, with the same frequency or with it having the same impact in the
criminal justice system as in the USA. For example, in the UK the polygraph was
only introduced in 2014 for
high risk individuals, it is by no means used with all people that have
committed a sexual offence, and is not admissible in court. Whereas in other
countries, like Australia, Israel, Sweden and New Zealand (to name a few) the
polygraph is not used with individuals that have committed a sexual offence.

Unfortunately, recent dialog has focused
more on choosing sides – for and against the polygraph – than sorting through
the various issues and balancing them against the human rights of each client
or examinee. We must keep in mind, in our desire to discover the truth and seek
answers from those that commit sexual abuse, that the consequences of false
positive (as well as the resulting conviction and related outcomes) can be
significant for victims and the accused.

Perhaps before we can answer questions
about the polygraph, it is better that we return to the basic questions of why
we do this work and what all our science tells us about the way people become
safer and grow beyond their traumatic experiences.

Thursday, August 16, 2018

Some recent social
media discussions have returned to the discussion of pornography and its place
in the treatment of people who have abused (as well as broader questions of its
place in masculinity and society). One case discussion involved an
intellectually disabled person while another considered whether it is
acceptable for men to look at women’s bodies. Setting aside the complexities of
the former and the inevitability of the latter, serious questions remain for
practitioners who attempt to balance risk management with client’s rights to
engage in behavior deemed legal/not illegal by high courts around the world. Let’s
be clear: we are not saying that pornography use is without risks. Author David
Ley has written an entire volume dedicated to ethical considerations in
pornography usage.

Where to start? A study by Drew Kingston and his
colleagues found that pornography use is a risk factor for re-offense primarily
among those who are already high risk and use pornography frequently. A new meta-analysis by Joshua
Grubbs and his colleagues describes how “pornography-related
problems—particularly feelings of addiction to pornography—may be, in many
cases, better construed as functions of discrepancies—moral
incongruence—between pornography-related beliefs and pornography-related
behaviors.” In other words, analysis of the data suggests that so-called
pornography addiction may have more to do with morality than with actual
addiction. It often seems that the only thing people can agree on is that more
research is needed. Sadly, there is no shortage of poorly constructed research
seemingly designed to confirm the various authors’ biases and appearing in obscure
journals and web sites.

All too often at
the front lines of practice, pornography is an inconvenient elephant in the
room that invites morality-laden rather than empirically informed responses. In
a conversation about the Kingston findings a participant became furious that
the subject hadn’t been framed in their preferred light. In another instance
involving an adult in group care who requested that he be allowed to possess
pornography similar to other clients, an outside consultant took to spreading
rumors about those who pointed out there was nothing in the client’s risk
profile to prevent his having it. These situations could potentially have had career-altering
repercussions. The concern in each instance is that people’s moral beliefs can
cloud their judgment about clients in their care, raising questions about who
gets to make the decisions about their own life and under what conditions?

Elsewhere, pornography can be more than just the elephant in the
room. It can be a source of embarrassment, scorn, rebuke, and debate. Although
everyone has an opinion on pornography and very few acknowledge watching it,
the viewing figures of “tube” sites like PornHub and YouPorn provide clear
evidence to the contrary (Psychology
Today piece on pornography viewing). Whatever our moral beliefs,
pornography usage is ubiquitous in those parts of the world with Internet
access. How this ubiquity will change people over time remains unknown, despite
our worst concerns. One wonders about the extent to which professionals in the
field of combatting sexual violence are engaged in hypocrisy, and to what
extent we cannot study the issues involved more openly or with greater
intellectual honesty.

The field of treating sexual abuse has not reached a point, where
we can have a detailed, nuanced, and adult conversation about pornography. The
debate tends to focus on abuse of power, humiliation, and gender; all of which
we agree with. In addition, there is a massive power imbalance in pornography.
All pornography is not the same, any more than all other forms of media are the
same. Obviously, there are large sections of it that are illegal, highly
problematic and have serious cause for concern (child sexual abuse, bestiality,
snuff movies to name but a view), but there are other forms of pornography that
are normal adult sexual relationships on show (for instance the debate around “ethical”
pornography and amateur pornography); however, while important (actually
essential) to flag these debates they are not the remit of this discussion (for
more information on the reality of Pornography we suggest the work of Maree
Crabbe). In many ways, the issues with pornography are the why, where, when
and how of its use; its context and need for viewers to engage. The fact that
we shy away from talking about sex, sexuality, and healthily relationships in
modern society holds us back from further clarity. Professionals and critics
can condemn people for watching pornography, but don’t ask why they are viewing
it, whether their usage is harmful to themselves or their relationships with
others, and if they have considered what is actually happening within it. There
is a very real question as to the ethics of condemning the viewer without
understanding the context.

These debates come to the fore where we think of certain populations
who can’t access sexual expression in the same way as others, either because
their primary sexual interest is in children or because their diminished capabilities
keep them under the care and/or guardianship of others.

As professionals who work in the field of sexuality and sexual
abuse we need to leave our moral issues at the door when engaged in practice
with individuals who view pornography, because our role is to help these
individuals and not to judge them, especially when we have power and influence over
them. We need to help people see what pornography is, what role it serves, and whether
its harmful to them (or others) help them stop engaging with it; but this needs
to be on a case by case basis and in a neutral way. Again, absent specific
empirically based risk considerations whose morality is it?

Thursday, August 9, 2018

Recent news
media events remind us of the importance of establishing the most helpful
directions for research and practice. For example, recent allegations of sexual
assault in professional contexts have captured the attention of many
professionals. In one instance, a university professor has identified himself
as a “survivor of sexual violence” after an alleged
incident of public groping in the elevator at a conference of the Society for
the Scientific Study of Sexuality.

Likewise,
recent legal manoeuvring by Brock Turner (whose light sentence in response to a
sexual assault on the campus of Stanford University) sparked outrage has again
made the news when his lawyers argued that his conviction should be overturned because his
crimes involved sexual “outercourse” and not intercourse. Likewise,
Bill Cosby has made the news by challenging his designation as a sexually violent predator in Pennsylvania and
a registered sex offender. Likewise, a search of
recent media accounts shows more instances of workplace sexual assault than can
be described here.

As much as
we applaud those who step forward in the wake of abuse and the media attention
that keeps this topic alive in public discourse, we also believe it’s vital to
keep in mind whose lack of privilege keeps them out of the media. As one
example, it’s important to keep in mind that being groped in an elevator at a
sexuality conference, while worthy of discussion, is not addressing the problem
of more severe sexual violence that happens in many communities and rural areas
every day. Brock Turner and Bill Cosby are easy media events; understanding the
context of sexual violence for less privileged people is much more of a
challenge.

Sadly,
privileged and photogenic people often receive our attention more than the
truly disadvantaged. This needs to change. Likewise, it is essential that our
field actively seek out opportunities to conduct research and provide
meaningful help where it is needed most. All too often, media accounts focusing
on who did what to who overlook the more important questions of what we can do
to stop these events from happening.

Those of us
who study and provide treatment in the wake of sexual abuse would be wise to
consider our own privilege, and how it focuses the lenses through which we view
sexual abuse. Of course, even saying this risks appearances that we (the
authors) are saying we are somehow “more enlightened than thou”, when we would
include ourselves in this caution. All of our media have an opportunity to
participate in dialog and debate these most difficult issues.

The lifetime
prevalence of sexual abuse in institutional settings in Germany was examined in
a sample representative of the general adult population (N = 2,437).
Participants completed a survey on whether they had ever experienced such
abuse, its nature (contact, noncontact, forced sexual, intercourse), the type
of institution (e.g. school, club), and the relationship of perpetrator to
victim (peer, caregiver, staff member). Overall, 3.1% of adult respondents
(women: 4.8%, men: 0.8%) reported having experienced some type of sexual abuse
in institutions. Adult women reported higher rates of all types than did men,
with rates of 3.9% versus 0.8% for contact sexual abuse, 1.2% versus 0.3% for
noncontact sexual abuse, and 1.7% versus 0.2% for forced sexual intercourse. We
conclude that a remarkable proportion of the general population experiences
sexual abuse in institutions, underscoring the need for development of
protective strategies. Especially, schools seem to represent good starting
points for primary prevention strategies.

The idea for this article has a long history. Since the “so called”
abuse scandals in 2010, the topic of child sexual abuse has gained a lot more
public and political attention in Germany.
Until this point there had only been a few studies on the prevalence of sexual
abuse and other types of maltreatment in Germany. So there was clearly a need
for data. Interestingly, those who came forward in the “so called” abuse
scandals in Germany were men who had experienced sexual abuse in institutions.
Additionally, one of our colleagues, Dr. Allroggen had conducted a survey with
adolescents that were living in institutions and found tremendously high rates
for experiences of sexual abuse. We were therefore interested in the prevalence
in the general population of sexual abuse institutions but also leisure activities.
Luckily, our department had the chance to participate in a large survey, so we
took the chance and included questions about sexual abuse in institutions and
leisure activities in the survey.

What
kinds of challenges did you face throughout the process?

A big challenge in research on sexual abuse is whether it is ok to ask
people for such experiences. Institutional review boards are sometimes hesitant
to approve such research due to concerns that asking participants about sexual
abuse will induce extreme distress. Fortunately, research on reactions of
participants exists that helps to adequately address these concerns. For example
Jaffe et al. (2015) report in their meta-analysis that trauma-related research
can lead to some immediate psychological distress, however this distress is not
extreme. In general, individuals find research participation to be a positive
experience and do not regret participation, regardless of trauma history or
PTSD. To present those findings helped that the IRB approved our research.

The other issue that we were facing was how to ask individuals about
their experiences of sexual abuse. There is no questionnaire that especially
assesses sexual abuse in institutions. Therefore, we had to be careful in
selecting the questions, as we needed the questions to be non-judgmental. Additionally,
when we were designing the questions we were interested in a range of related
topics and would have liked to include a lot more questions but resources are
limited and so we had to narrow our questions to the essential ones.

What do you believe to be the main things that you have learnt about the prevalence
of Sexual Abuse in institutions?

One of the most compelling findings is the amount of people that are
affected by sexual abuse within institutions. We also find that experiences of
child sexual abuse, as with other types
of child maltreatment, is very common in the general population. When we investigate
specific populations, such as children living in institutions the rates are
even higher. Our findings also suggest that sexual abuse may occur in a wide
variety of settings and that adult caregivers or staff, as well as peers have
to be considered as potential perpetrators. Clearly, efforts have to be taken to
prevent sexual abuse in different settings and also in regards to perpetrators.

Now that
you’ve published the article, what are some implications for practitioners?

Sexual abuse in institutions is an issue. The results of our study
indicate that a substantial number of people are affected. Therefore asking about
such experiences is necessary, to understand peoples behaviors and health, because
we know about the negative and lasting potential of such experiences.
Additionally, our results suggest that prevention programs should be
established. Especially schools seem to be a good setting for such programs.
Additionally, such programs should also address peers as potential
perpetrators.

Kieran McCartan, PhD

Chief Blogger

David Prescott, LICSW

Associate blogger

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The Association for the Treatment of Sexual Abusers (http://atsa.com/) is an international, multi-disciplinary organization dedicated to preventing sexual abuse. Through research, education, and shared learning ATSA promotes evidence based practice, public policy and community strategies that lead to the effective assessment, treatment and management of individuals who have sexually abused or are risk to abuse.

The views expressed on this blog are of the bloggers and are not necessarily those of the Association for the Treatment of Sexual Abusers, Sexual Abuse: A Journal of Research & Treatment, or Sage Journals.

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